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Midlife high blood pressure tied to later mental decline

NEW YORK — People with high blood pressure in middle age are more likely to experience cognitive decline — a common precursor of dementia — in their 70s and 80s, according to new research.

The U.S. study spanning 20 years found steeper mental decline at the end of that period among people who started out with hypertension or even slightly elevated blood pressure —prehypertension — in their 50s and 60s.

These new results strengthen a link experts already knew about, lead author Dr. Rebecca F. Gottesman said. High blood pressure has been tied to an increased risk of stroke and dementia in other studies.

“Basically the amount of decline we see associated with hypertension is pretty modest, but this amount is equivalent to being 2.7 years older at the start compared to not having it,” noted Gottesman, from the neurology department at Johns Hopkins University School of Medicine in Baltimore, Md.

She and her team used blood pressure and mental performance data from the early 1990s for more than 13,000 adults between ages 48 and 67. More than 5,000 remained alive and available for more testing between 2011 and 2013.

After the first round of mental tests and blood pressure readings in 1990-92, the verbal, memory and math tests were administered two more times, in 1996-98 and in 2011-13.

People with hypertension at the start were twice as likely to have died by 2011 than those without it, according to the results published in JAMA Neurology.

For those still alive, having high blood pressure at the first round of tests was associated with 6.5 percent greater decline in mental performance at the last round of tests than was seen in people with normal blood pressure.

For people with prehypertension, the rate of mental decline over the same period was somewhere between those with hypertension and those with normal blood pressure.

The differences are not huge, Gottesman said, but being the equivalent of 2.7 years older mentally means that Alzheimer’s disease, if it comes, will come earlier, and for the population in general that would be an important difference, she said.

By age 40, people should be keeping track of their blood pressure, and perhaps earlier if they have a family history of hypertension, Gottesman said.